Treating a Recalcitrant Non-union of the Radius Using Autogenous Bone, Equine Bone Paste, Equine Demineralized Bone Matrix, Platelet Rich Plasma, and Bone Marrow Aspirate. A Case Report.
Abstract: Non-unions at forearms are usually challenging and difficult to treat. If additionally, an infection is present, reconstructive surgery should be planned only after full debridement, antibiotic treatment, and confirmation, based on clinical observation and laboratory tests that the infection has subsided. Bone grafting may be required for reconstruction. The use of autogenous bone calls for a second surgical site with an increased risk of morbidity. Using bone substitutes may reduce the need for autogenous bone. Stimulating factors, such as bone marrow concentrate (BMC) and demineralized bone matrix (DBM), may be used concomitantly with bone substitutes to facilitate bone regeneration. Methods: The present report describes the case of a 38-year-old patient whose radius was fractured in a car accident. A first surgery involved stabilizing the reduced fracture with a plate, but an infection developed, and the bone did not heal. 3 months later, a second surgery followed, involving placing an antibiotic-filled spacer. This did not cure the infection, so the spacer was replaced 3 months later, and a second antibiotic was added. The patient also began taking oral antibiotics. 6 months later, the patient underwent vascularized fibular grafting. However, the graft did not integrate, and a non-union developed. A year later, the non-union was treated by grafting autogenous bone from the iliac crest, equine bone substitute, and equine DBM, in conjunction with autologous BMC and platelet-rich plasma. At the 6-month follow-up, the bone structure appeared to be successfully reconstructed. Conclusions: A graft made of a combination of materials with both biological and physical properties can be used to foster bone regeneration for the treatment ofparticularly challenging cases ofnon-unions.
Publication Date: 2018-03-31 PubMed ID: 29600207PubMed Central: PMC5868880DOI: 10.13107/jocr.2250-0685.938Google Scholar: Lookup
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Summary
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The study is centered around a unique approach to treating a stubborn non-healing fracture in the radius (forearm bone) of a 38-year-old individual using a diverse combination of remedies such as autogenous bone, equine bone paste, demineralized bone matrix, platelet rich plasma, and bone marrow aspirate.
Background of the study
- This study is based on the treatment of a stubborn or “recalcitrant” non-union break in the radius bone of a 38-year-old patient who had sustained the injury in a car accident.
- Non-unions are fractures that fail to heal, and in this case, the difficulty of treatment was compounded by the presence of an infection in the fracture site.
- Standard procedures for resolving such an infection were undertaken – surgery to clean the wound (debridement), long-term antibiotic treatment, and the placement of an antibiotic-filled spacer – all of which unfortunately failed to cure the infection.
- The article explains how these complications necessitate advanced treatment methods including bone grafting and reconstructive surgery.
Methods
- The study collaborates a specific case scenario where a number of treatment methods were undertaken, including the use of an autogenous bone graft – a procedure that uses bone harvested from the patient’s body, in this case from the iliac crest (the large bone of the hip), thus creating another wound and potentially introducing more complications.
- Additional techniques were used to stimulate bone regeneration. These included equine bone paste, equine demineralized bone matrix (DBM), bone marrow concentrate (BMC) and platelet-rich plasma.
- The DBM, BMC, and platelet-rich plasma all act as biological stimuli to promote healing and bone regeneration, while the autogenous bone and equine bone paste provide the physical scaffolding for new bone to grow.
Outcomes
- Following the concerted use of these therapies, the patient’s radius appeared to have successfully reconstructed at the 6-month follow-up.
Conclusions
- The study suggests that the use of a combination of materials with various biological and physical properties can effectively foster bone regeneration in the treatment of particularly challenging cases of non-unions.
- That said, additional research with larger patient populations would be needed to confirm the effectiveness and reliability of this treatment strategy.
Cite This Article
APA
Lorenzo FDR.
(2018).
Treating a Recalcitrant Non-union of the Radius Using Autogenous Bone, Equine Bone Paste, Equine Demineralized Bone Matrix, Platelet Rich Plasma, and Bone Marrow Aspirate. A Case Report.
J Orthop Case Rep, 7(6), 31-35.
https://doi.org/10.13107/jocr.2250-0685.938 Publication
Researcher Affiliations
- Department of Orthopaedics, Institute Codivilla-Putti, Via Codivilla, 132043 Cortina dAmpezzo, Belluno. Italy.
References
This article includes 13 references
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